Posted
by
msmash
on Friday May 19, 2017 @01:00PM
from the going-forward dept.

Four years ago professor Sally Davies, England's chief medical officer, gave the world a sombre warning of the growing threat posed by bacteria evolving resistance to life-saving antibiotics. If this were left unaddressed, she argued, it would lead to the erosion of modern medicine as we know it. Doctors and scientists had long warned of the problem, but few outside medicine were taking real heed. Consumption of antibiotics rose 36% between 2000 and 2010, writes Ed Whiting, director of policy and chief of staff at Wellcome, a biomedical research charity based in London. He notes that much of the progress in the field is yet to be made:We urgently need new antibiotics. No new classes of antibiotics have been approved since the early 1980s. Between 1940 and 1962 about 20 classes were produced, but industry backing has decreased significantly since that golden age. The pipeline of new treatments is all but dry, the void fast exploited by resistant bacteria. A concerning number are now resistant to drugs reserved as the last line of defence, and the most vulnerable are in greatest danger -- the young, old and critically ill. Blood infections caused by drug-resistant microbes kill more than 200,000 newborn babies each year. The reason for the lack of interest from the pharmaceutical industry is simple: the economics don't add up. Developing new antibiotics is scientifically challenging, time-consuming and costly. The medicines we so badly need cannot be allowed to be sold in volume; they must be conserved for real need, with fair access guaranteed. This limits their retail value. Many early-stage projects will fail, making them a risky bet. Even those that are successful will take at least a decade to produce medicines that are safe for human use.

American Independence wasn't based on threats and puffery (as least, from the US side), though admittedly there was some at a local level.

We were prepared for violence. We knew violence was likely. But we didn't just randomly start shooting royalists for the most part (violence against local royalists leaders, pre-war, isn't a part of our history I'm proud of). The British decided to send troops to confiscate guns. We decided not to let them. It sort of escalated from there. Military action, not punc

Violent self defense is still violence.Loyalists rising up, military coming across the sea, brother fighting brother, etc. was self defense from their point of view.Just as both sides in the Civil War were defending what they believed in.

Saying you see no problem with someone getting an infection is very very far from threatening political violence.

The poster said nothing about "getting" an infection. The poster said they would not see anything wrong with "giving" him an infection. There's a difference between wishing ill on someone and supporting the idea of actively causing harm to someone.

Considering what Erdogan's guards did to peaceful protestors during the recent white house visit, and considering Trump appears to have said nothing about it, I'm a little worried anyway. I mean, Trump studies fellow democratically elected popular presidents from other countries very well...

I'm with you. As long as you are just as willing to condemn similar threats of violence against the other party, such as those that were directed at Obama,https://www.washingtonpost.com... [washingtonpost.com]

So you believe that a million years of evolution happened over night and now there are superbug boogeymen ready to eat you alive????

No, 75 years of bacterial evolution happened in 75 years. That's probably around 1e6 generations, a number which was sufficient for humans to evolve from rather primitive mammals, and it's certainly more than enough generations to to breed superbug bogeymen ready to eat you alive. (Certain bacteria were in fact always able to eat you alive, it's just now they've bred resistance to a handful of chemical road bumps we came up with.)

My dad has an infection in his arm which is only being moderately helped by intravenous Cipro and Vancomycin. They've sent a culture to Mayo to see if they can find a better treatment option but at this point I'm more than a little concerned. This stuff is already happening. They really need to get their heads out of the sand.

The worst part is, if a new antibiotics is discovered, it might help you right now, but after a couple of year, because of over use(*), the bacteria will eventually evolve some resistance against it. So the next patient with the same kind of infection will be again in the same situation...

Maybe time to dust off alternative therapies, like phage therapy [wikipedia.org] ? (**)Cue in citation of your favorite strategist (Churchill, Sun-Tzu, Machiavelli, etc.) commenting about the millennia-old proverb that the enemy of your enemy is your friend.

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(*) : over-prescription, industrial/agricultural use, etc.

(**) : phage are like viruses but specialize in infecting bacteria. So phage therapy is basically curing your sickness, by making your sickness itself sick, with its own sickness, in a kind of pathogen-ception.

It depends. It's pretty rare for a bug to be resistant to all available antibiotics. There are a few notable exceptions, but proper management of antibiotic use reduces the threat significantly. A few extra options to choose from also helps. The problem is that making your money back on new antibiotic development is hard, for a variety of reasons.

Maybe time to dust off alternative therapies, like phage therapy [wikipedia.org] ? (**)

Cool idea, but still very much in the basic research stage. There are a few once-off success stories, but turning it into a large-scale therapeutic is very challen

Phage therapy already receives renewed interest and bacterias will also evolve resistance against it.
IMO the real problems are (as you said) overuse but also lack of incentive (commercial) to develop new antibiotics.

Plus, the antibiotics given to animals are very weak so you're comparing apples and oranges.

No. It's now be proven that some antibiotic resistances came from particular farms. And they are not 'weak': they are supposedly given in small quantities, but the 5$-hour workers shoveling it in the feeds don't necessarily respect the quantities. When you know that without antibiotics 1 out of 9 skin infections in humans lead to death, you really have to wonder if feeding this to cows is worth it.

2. it's fucking bizarre watching the insane mental gymnastics of someone determined not to see that agribusiness and pharma corporations don't give a fuck about humanity or the long term problems they cause by using antibiotics on farm animals as long as there's some short term profit in it.

3. i bet you're the kind of fuckwit who demands antibiotics from your doctor for a cold or flu - in total ignorance of the fact

That's bad. Very bad. Because now you've created an environment which knocks off the weak strains of bacteria making room for more robust strains. If you can't administer something strong enough to kill them all, just don't bother.

How about giving farm animals a bit more living space? And more of that outdoors. So when a chicken gets sick, they don't pass it to half a million other chickens crammed in the same factory.

So, sell the land and move the operation to friendlies territory. Tell the Democrats no more local produce. And enjoy 300k acres of strip malls, apartment blocks and huge parking lots that will replace your farm.

Perhaps the corporate farm can't get zoning not because of "dem damn librul democrats" but more the fact that 300K acres is 468 square miles, meaning basically the equivalent of a square piece of land of 21.5 miles by 21.5 miles. Notice the word, MILES.

Perhaps the farm already consumes so much land that there isn't anymore to spare.. That acreage is larger than some entire COUNTIES.

The corporate farm I work for has about 300k acres, and we want to do that but we're mostly in Democrat-ruled areas so we can't get the zoning done.

Perhaps you can't get zoning not because of "dem damn librul democrats" but more the fact that 300K acres is 468 square miles, meaning basically the equivalent of a square piece of land of 21.5 miles by 21.5 miles. Notice the word, MILES.

Perhaps the farm already consumes so much land that there isn't anymore to spare for you. That acreage is larger than some entire COUNTIES.

"Plus, the antibiotics given to animals are very weak so you're comparing apples and oranges. When we buy them by the kg, you're going to buy the cheapest thing available."

I'm sorry but you are wrong. Dead wrong. The cheapest antibiotics are not the weakest, they are old antibiotics that are very powerful and broad spectrum. Doctors have started prescribing other treatments not because they are "stronger", although you'll often hear that but because they are useful for a much smaller spectrum of infections

Oh boy. You really just made up some shit about antibiotics didn't you? Full disclosure...actively practicing inpatient medical provider here with family practice background and infectious disease training. I prescribe antibiotics.

First off, Amoxicillin is very narrow spectrum. It is also prescribed incredibly commonly despite your claim to the contrary. It is one of the most common pediatric outpatient antibiotics specifically because of it's narrow spectrum of activity and excellent safety profile. It will not knock out "almost any infection you could have." It kills gram positive organisms almost exclusively. Since it is susceptible to penicillinase producing organisms, resistance is reasonably common. Further, it has no, or little, effect on most gram negative organisms because it acts on the components of the bacterial cell wall which are present primarily in gram positive only organisms. Calling it "strong" or weak implies a misunderstanding of antibiotics. While we often use "strong" to imply broad spectrum, any antibiotic is "strong" if it is used against an appropriate organism.

Your suggestion that the newer antibiotics are strictly narrow is flat out wrong. The newest antibiotics in common clinical use are the carbepenems which came into clinical use in the 80s and they are vastly broad spectrum.

The "old" antibiotics are not particularly broad when compared to the newer generations of carbepenems which we utilize heavily in the hospital. Some old antibiotics are narrow spectrum, some are broad. You're making a vague and unsubstantiated claim.

The only thing you are correct in is that you are right that we often prescribe narrow spectrum antibiotics when possible so as to avoid resistance patterns. But this isn't "strong" versus "weak" antibiotics, this is just good antimicrobial stewardship.

Huh? It's the socialists that are fighting to deregulate drugs and take control of drugs from the medical cartel.... It's the doctors in the US that proscribe the strongest and most expensive antibiotics that are creating the problem because they love profit more than humanity.

I'm honestly confused. Are you arguing socialists are the problem here or capitalism among doctors is?

If you think about it, the microbiological market is sorting this out.

The microorganisms are allowed to fully develop without any government interference or constraints. Market forces at work:) It is an upside for microorganisms, but the downside is that we can never go to the hospital or have elective surgery without risk of being consumed by microbiological market forces.

What we really need are living antibiotics that evolve with the microorganisms. Bacteriophages [wikipedia.org] seem like a good weapon of choice.

Government grant money wouldn't have averted this problem, and would only be a band-aid now. The reason we reached this point is because the prices of the current crop of antibiotics externalized their true cost (i.e., the cost of developing new drugs due to the overuse and thus the increasing ineffectiveness of the existing ones). Just another act in the tragedy of the commons [wikipedia.org].

Without addressing the overuse problem, government grant money is at best only going to create the next generation of increasingl

But as an excuse, relevant industries definitely would argue "it'll solve itself" or close enough. Big agriculture lobbyists are likely arguing that to republican lawmakers right now, saying "look, we've 'voluntarily' reduced our use of the emergency antibiotics, so we don't really need to go *chuckle* 'organic' right? We'll take steps to reduce it on our own while saving jobs in your district, hint hint."

The claim doctors make is similar: "People are demanding antibiotics less, we just need to educate the people (who are ignorant and stubborn enough to still be demanding antibiotics for every cough and thus are never going to listen). If I tell them no, they'll just go to someone who will say yes! It's hard being a doctor!" Somehow that's the justification I get when I say "Hey, how about we put doctors in jail for prescribing antibiotics without a lab test showing it's bacterial?"

So yes, I think it's worth pointing out that the free market will never solve any problem more complex than "Which of these apples are cheaper?" because people ARE that ignorant, and selfish interested parties DO suggest the problem will solve itself.

But the discovery itself was not obvious, and it was made by someone highly skilled, who had been trained and supported in decades of government science.

The discovery isn't even the most important thing, though. It was developed into a useful drug not by Fleming but by a chain of other people who were also supported by government science.

(Fleming was, as it happens, my father's supervisor for a time during the final stages of his medical training; he has told me in the past that Fleming didn't court the credit he has been given, and continued to credit where it was due, because the drug was actually mass produced through the work of others just as skilled as him.)

But the discovery itself was not obvious, and it was made by someone highly skilled, who had been trained and supported in decades of government science.

The discovery isn't even the most important thing, though. It was developed into a useful drug not by Fleming but by a chain of other people who were also supported by government science.

(Fleming was, as it happens, my father's supervisor for a time during the final stages of his medical training; he has told me in the past that Fleming didn't court the credit he has been given, and continued to credit where it was due, because the drug was actually mass produced through the work of others just as skilled as him.)

But Fleming sucked at speaking so his discovery sat. It was Paine who made it a medical cure, and then Florey, who showed it was effective in fighting bacterial infections. So while Fleming made the discovery, he never tested it in infected animals and others stepped up and showed it's potential.

We still know about germ theory, so we would still be sterilizing scalpels and tongs with heat or alcohol or whatever. And we have xray machines and anesthesia and all that other good stuff, so it's still gonna be way better than medicine in the dark ages.

Making new stronger antibiotics is only a temporary solution, bacteria will probably develop resistance to that too.

What's probably gonna happen is that surgery will become risky and very expensive. Everything in the surgery room will need to be sterilized extremely thoroughly, and you would need super air filtration systems like a CPU manufacturing clean room. Even then risk of infection will always be there. So you would only want surgery in life-threatening situations. No more nose job or tummy tuck or a hip replacement. If you have a bum hip, you're gonna be walking around on a cane or in a wheelchair like our ancestors did.

And we'd see the first reductions in life expectancy once these resistant bugs become widespread. Its not that we'd return to the Dark Ages, but lifespans would be reduced to the levels currently seen in sub-Saharan Africa.

new antibiotics aren't going to be profitable. For one thing the drug companies make plenty on the existing ones. For another they're too essential for life, so they're prone to price controls. We could make them profitable enough but only by allowing business practices similar to what Epipen's Pharma Bro did.

This is what "Austerity" and rampant non-stop tax cuts gets you. This is something the government needs to step in and do. The days of one bright guy with a petri dish making a major breakthrough a

Currently. Do you think they are blissfully unaware of the possibility of a future where their current products are ineffective? Given likely know the time required to get such a thing approved (after the similarly long time to do the research), don't you think they'd be looking at future opportunities?

For another they're too essential for life, so they're prone to price controls.

and existed before the complex games companies play to keep things in patent control.

And yes, they were massively funding research. Not into new antibiotics, because that's a fairly recent issue (last 20 years tops). But the cancer drugs that kept my kid alive were invented by the government (or Europe, research into childhood diseases isn't profitable enough to do it here in the States and, well, aforementioned tax cuts).

* We don't have the tax revenues to pay for half the programs the government wants to fund.* We had been borrowing money for the other half.* No one will lend us any more money, because we're clearly never going to pay our debt off given our spending history.* We're stuck, no possible/I. way to keep spending at current rates

But, hey, maybe if we show lenders some evidence we're capable of spending less, cutting some programs we like, maybe they'll lends us at least a little. That's better than cutting half the programs to get back to tax revenue, right?

Austerity isn't some weird tickle-down economic theory or anything. It's what you do because you must, as for one reason or another, you can't print money to make up the shortfall.

The Keynesian method, which nobody seems to practice, is to have some austerity going in good times and forget about it in bad. Too many countries seem to forget about trying to save in good times (the Clinton administration is an exception). Austerity in bad times generally makes them worse. It's cost the Greek economy dearly.

Raising taxes only works up to a point. In places like Greece, where austerity is actually a thing, they've taxed everything possible. In the US, we've never sustained federal tax revenue above 19-20% of GDP, despite a wide range of tax approaches, from 90% top bracket on down. That's not to say whether raising taxes from here would be a good idea, but then we're not facing austerity measures in the US to begin with. We can just print money (and have been, in a new way, with QE).

For anything more important than a twinkie you need an organized response, i.e. the government.

And yet we keep hearing about how wonderful socialized medicine is in countries that have it.

Why do those countries expect private pharmaceutical companies to develop drugs instead of funding the development themselves? And why do people in those countries expect to get the drugs at deep discounts compared to what the drugs sell for in the US? It's time for other countries around the world to open their wallets and pay for some of the R&D.

but not for the reasons you're probably thinking. Those words weren't uttered by a government agent (one of those paid for my kid's cancer treatments and the research that made those treatments possible). They come from a right wing think tank. They were engineered to make the working class turn on each other and on the primary source of organized power they possess: Democracy.

fun fact: many of these antibiotics are developed through public private partnership with your local schools and universities under nondisclosure agreements which prevent any of the research from being made public. these NDAs often have expiration dates as far far as 80 years into the future.

the fact remains that if and when the cloistered elite need access to lifesaving medicine en-masse, these drugs will be quickly made available. If the cure for Hepatitis C was any indication, you'll certainly gain access to these advanced new antibiotics as well...at $30,000 a bottle.

If a college receives any public funds, than any research should be owned by the public. Any derivatives as well. Therefore, and/all penicillin based antibiotics should be profit-and-prescription free.

Whenever I read a statistic like Consumption of antibiotics rose 36% between 2000 and 2010 I wonder what they had to do to boil it all down to one number. For all I know this is accounted for mostly by a single drug being administered to farm animals ? It sounds like a shocking number but it means very little to me. Even a little more information would have been really helpful and help me feel like it wasn't a statistic created for wanton shock value.

First, get antibiotics out of agriculture, where they're given _all_ _the_ _time_ as a preventative measure. Stupid.

Second, why exactly should access be "fair"? TFA complains on moment that there's no economic incentive, and then promptly demands fairness. Get real. Life isn't fair. But what the rich can buy today will be available to the rest of us tomorrow.

Good thing we have the for profit industry in the US. With all those dollars guiding them we should have a solution by next week. Of course, only the 1% may be able to afford it anyway, but citizens in single payer countries will be ok.

Good thing we have the for profit industry in the US. With all those dollars guiding them we should have a solution by next week. Of course, only the 1% may be able to afford it anyway, but citizens in single payer countries will be ok.

So the money from single payer countries will have a solution by next week?

While this will be a tragic turn of events for millions or even billions of people, ultimately we will be forced to seek a new path of technology to sustain our bad behavior. As they say, "necessity is the mother of invention". It will be a long hard road but we will reach the end and develop something akin to synthetic microbes that do exactly what they are programmed to do. Frankly, with the last few centuries so focused on killing each other, humanity could use the diversion to actually work on protecting ourselves from the ever-present invisible enemies that are microbes.

It's a hard road we face but after much death and suffering we will come out stronger as a species.

Geezus, I keep posting this. Antibiotics are great and all, and limiting nonessential use is great and all, but we really need a Plan B. A serious alternative way of treating drug resistant infections.

And we already have it!

It is called phage therapy and it is completely different. Viruses have been attacking and eating bacteria for literally billions of years. This predates multicellular organisms and so we already know how effectively bacteria can develop immunity to viruses (hot tip: they can't! If

If we weren't so focused on the failing strategy of "look for MOAR antibiotics", we could have had the superbug problem licked already with alternatives like phage therapy (which you can only get right now if you fly to Georgia).

What does it tell you when the famed "merkan innovation" can't even out innovate a tiny former soviet republic using 90yr old tech?

Between climate change and overpopulation isn't this just a way to cull the herd? People survived before antibiotics, and the genetically strong will survive the loss of antibiotics. It won't be pretty though.

There's a point to be made here. The dark ages bit is hyperbole, the vast majority of what goes into you being healthy is prevention, sanitation, gloves, and not throwing your feces into the street.

A lot of people these days seem okay with returning to the dark ages in terms of science and learning vs religion anyway. And they don't seem very sympathetic to sick people either. Maybe instead remind them that before antibiotics, soldiers died of infections nearly as often as they did of battle. Right wingers still care about soldiers right? At least in terms of their health BEFORE they fight?

Politicians care about themselves and their ability to remain in power. If they can kill soldiers and remain in power, they will do so. If they can ignore a health crisis and remain in power, they will do so. If they can drag their feet while pretending to address an issue, they will do so. If, however, an issue directly affects them, they'll rapidly act to address it.

To show that this hasn't changed for hundreds of years, I give you The Great Stink of 1858 [youtube.com]. (WARNING: Do not watch while eating.)

True, medicine would only be returned to about its state in 1910, or perhaps 1900. Operations, even minor ones, would be a bad gamble with death...even when the best choice. Anesthetics would continue to be known and effective, but any incision could be fatal. Perhaps UV could substitute for some antibiotic uses, and strong poisons could be used to swab down surfaces, and disposable gloves and clothing could minimize risk. And... But we're already doing most of those things, and bacteria still get through.

OTOH, I'm not sure that new antibiotics are the solution. Managed bacterial ecology might be a better approach. This would include applying predatory bacterial strains selected for effectiveness against the infecting bacteria, and would also include disrupting bacterial culture communication networks. Etc. It might also include quite specific antibiotics that were effective against only one particular strain of bacteria...but those would be expensive to develop, you'd need a lot of them, and it would req

Skinner: Well, I was wrong. The predatory bacterial strains are a godsend.Lisa: But isn't that a bit short-sighted? What happens when we're overrun by predatory bacterial strains?Skinner: No problem. We simply unleash wave after wave of Chinese needle snakes. They'll wipe out the predatory bacterial strains.Lisa: But aren't the snakes even worse?Skinner: Yes, but we're prepared for that. We've lined up a fabulous type of gorilla that thrives on snake meat.Lisa: But then we're stuck with gorillas!Skinner:

medicine would only be returned to about its state in 1910, or perhaps 1900

Incorrect, due to a number of factors: in the early 1900's, most people weren't subsiding on diets primarily consisting of nutritionally-devoid, pesticide-ridden, genetically-modified sludge processed primarily from wheat, corn and soy. They received more exercise on average as well as more sunlight (the pharmaceutical industry's efforts to vilify sunshine - one of the most important parts of a healthy lifestyle and an obvious threat to their profits - have been wildly successful) and lived far less complic

The fact that we even have germ theory is a huge improvement over even the 1800s. The advances we have that antibiotic resistance can't negate include, but are not limited to:

Sterilization*

Gloves and Handwashing*

Vaccinations*

IV administration of fluids

modern sanitation

These advantages put is far above our ancestors, for example we're not all going to suddenly get cholera just because it's become resistant to antibiotics. Even with antibiotics, the Bubonic Plague is still absurdly lethal, but in modern tim

It's why you fund academia to do the research and why government agencies do have a place in medicine. That model fits this problem much better than simple commerce.

Agreed. Of course, the real question we should be asking is this: If government agencies and government-funded academia can (and, indeed, must) do the research, why do we need drug companies? Shouldn't we just cut out the middlemen and have the academic institutions and government agencies contract out the manufacturing directly?

If you think that government research leads to a usable pill, then you don't really have any clue what you're talking about.

"Evil corporations" are the ones that spend the money to implement stuff and see if it actually works. Quite often, the pure research fails to yield a useful drug and that private investment is wasted.

People who accept the government role in defense, but don't in health care and national health ignore the fact that we are in a never ending war with the bacteria and fungi. A health care system as a part of an integrated civilian and military defense system is a defensive front of the nation and the human race, even if the enemy doesn't have a color or creed.

And, what's worse, the enemy outnumbers us, is stealthy enough that you don't know you've been hit by them until after the fact, and can oftentimes ad

Socialists will happily tell you that drug development is actually a government enterprise.

We spend a great deal of money on new drug development. A bit less than half is basic research funded by the government. The larger portion is the final development process required to create an actual product. Private enterprise handles that.

The final push to market is both extremely risky and extremely expensive. If you gut private economic incentives, you will be slitting your own throats.